Q: And what about Geisinger's Center for Clinical Innovation – one whose main goals is to "leverage IT and advanced analytics to support population health." What are some gratifying things that have come out of there, recently?

A: We have changed expectations with regard to how we treat patients with serious chronic disease. Type 2 diabetes was just the first one in a list. We've now expanded it to coronary artery disease, to COPD, to hypertension.

But probably our longest-lived commitment was to treat type 2 diabetes patients – there were probably 27,000 or so that we started with, almost eight years ago – to create a set of aspirations, a set of data feedback loops and to change our incentives, in terms of how we pay our primary care physicians. And really commit to a bundle of nine best-practice goals being achieved in all of these type 2 diabetics that we took off the shelf from all of these endocrinologists and diabetologists, but had never previously been engineered into the expectations for trying to achieve 100 percent of those goals in 100 percent of the diabetic patients.

After three years of improvement in these 27,000 patients, getting all of them up to and optimal for all nine of these expectations, it took only three years before we saw a significant diminution in their risk for heart attacks, for strokes, for amputations or for diabetic retinopathy.

For me as a clinician, someone who actually used to take care of patients, I mean, that's amazing – to actually see, after only three years, a beneficial effect on diabetes-related secondary disease.

Now we haven't even done the economic analysis of that, but presumably, if you're avoiding heart attacks and strokes, you're probably avoiding a lot of hospitalization – high-cost and high aggravation treatment.

Q: If healthcare is just now entering the 19th century, as you said, what will it take to get us into the 21st? Will we have to wait 200 years, or will it come faster than that

A: Oh no, I think we're in the midst of just huge change right now, and I think what it's going to take is winners and losers. We're going to have organizations that figure it out and also have a viable business model, and they're going to be different than what we see now, with this compartmentalized, fragmented, mom-and-pop industry.

That change could be painful. It's kind of like the grocery business 120 or 130 years ago – the supply chain issues and the consolidation and what have you put almost all of the small grocery stores out of business. On the other hand, the amount of household resources that use to go toward groceries – it used to be up to about 30 percent of discretionary money for a household – has gone down to low single digits now. And guess what's happening to healthcare.

I think this change is going to be extraordinarily fast. I think it's going to be quite disruptive, and I think there will be winners and losers. And my only wish would be that I was younger. If I had my experience and my knowledge now, and I were just beginning, in the midst of this transformation, I could do some real damage.